Fighting for Recognition: The Emotional Battle of Undiagnosed ADHD in Women

In today’s world, social media is highlighting ADHD and providing more information (some correct and some not) for individuals to understand this often misunderstood and even discredited complex condition. If you are self identifying with the symptoms of ADHD, you aren’t alone. Many women are becoming aware that they may be living with undiagnosed ADHD.

If you have always felt like something was wrong, or felt different from others but didn’t have the language to articulate why, finding this information might bring a sense of relief. And knowing that you are one of the (too) many women with undiagnosed ADHD is just the first step in your journey of understanding yourself.

The primary reason women with ADHD are fighting for recognition is because they are chronically under diagnosed and often misdiagnosed with depression and anxiety.

You may be depressed and anxious but that could mostly be due to living undiagnosed for so long and having to constantly compensate and mask. For women with undiagnosed ADHD, seeking a diagnosis is an uphill battle. This is because girls and women often present differently than boys and men.

Research on girls and women with ADHD didn’t start until the 1990s. Because of this late start, there is still a significant void in our understanding. Many people still think of ADHD as a behavior issue that only affects little boys. Some think it is made up or even an excuse.

The truth is, ADHD is a chronic and severe neurological condition. It is the 4th most common psychological issue for adults in the US.

A 2006 study states that ADHD affects 5.3 million women in the US but some researchers believe that less than 20% of all women who have ADHD are diagnosed.

What we do know from the research done by Dr. Stephen Hinshaw at the University of California, Berkeley is that girls and women who live undiagnosed or untreated often:

• have increased depression and anxiety
• are more likely to engage in self-harming behavior
• are more likely to be diagnosed with chronic stress disorders and fibromyalgia
• are more likely to engage in eating disorder behaviors
• struggle with sleep disorders
• are more likely to be diagnosed with a substance use disorder
• engage in riskier sexual behaviors resulting in unplanned pregnancy or a sexually transmitted infection
• have a marked increase in other impulsive behaviors
• have marital difficulties (marital difficulties are common whether it is the male partner with ADHD or the female partner with ADHD)
• are at a greater risk of suicide

According to Dr. Kathleen Nadeau, if ADHD in girls goes untreated, there are additionally more severe psychiatric disorders experienced in adulthood compared to males who go untreated.

So why else is undiagnosed ADHD in women so common? It can start when we are young girls.

Many times, symptoms for boys can start early but symptoms for girls may not show up until puberty.

Girls who are people pleasers are motivated to perform well academically for fear of disappointing others. This is helpful, but not positive if she struggles with activation.

It is the fear of disappointing others that is the motivator.

Girls are good at masking and coming up with ways to cope and manage symptoms, and this comes with a cost.

It results in excessive anxiety. So, healthcare professionals must assess for ADHD when presented with anxiety symptoms to see if ADHD is the root cause. But unfortunately many don’t assess for ADHD.

As girls get older (if they continue to live undiagnosed or untreated) they can feel more overwhelmed with everyday activities or demands, become more disorganized, can be consistently late, struggle to maintain household responsibilities, and feel chronic shame for all of the above.

All of these things can also impact relationships, leaving her to feel more rejected, judged, criticized, and incredibly alone.

Then there is the myth that if a person has ADHD, they cannot be “successful”.

It perpetuates the false belief that if graduating from college, or earning a higher level degree, one can’t have ADHD. Even psychological testing can miss symptoms. If she is highly intelligent, doesn’t struggle with learning differences, isn’t disruptive at home or school, and has good social connections, she will often be missed.

Doctors who only use the DSM-5 to diagnose ADHD can also misdiagnose someone because the criteria isn’t comprehensive enough.

In 2024, APSARD, the American Professional Society of ADHD and Related Disorders, will be publishing guidelines for assessment and treatment for adults with ADHD.

Too many girls and women are feeling unheard, misunderstood, and even gaslighted when trying to get an appropriate diagnoses of ADHD and support. Clients tell me their healthcare provider believed they only identified with symptoms they saw online because of confirmation bias. Other clients have told me their healthcare provider questioned if they were drug seeking instead of taking their concerns seriously.

If you believe you are one of the many women living with undiagnosed ADHD, ADDA and CHADD are great resources for getting the help and support you need.

Jacqueline V. Cohen is a licensed professional counselor and an ADHD-certified clinical specialist provider specializing in perinatal mental health and adult ADHD. To learn more about her services, you can go to her services page.